Patients from deprived areas less likely to get specialist end-of-life care, study finds

Patients with breast, bowel, prostate or lung cancer living in the most deprived parts of the country are more likely to be admitted to hospital as an emergency case in the last six months of their lives compared to those who live in the most affluent regions.

Charity Macmillan Cancer Support, which funded the study, said the findings highlight the variation in access to specialist end of life care across the country.

It said that having access to the right care and support should not depend on where a patient lives.

The study - conducted by researchers from City, University of London and the Economic and Social Research Institute - analysed data on 250,000 patients from the English National Cancer Registry.

It found that people with the four most common types of cancer are more likely to be admitted to hospital as an emergency in the last six months of their lives, increasing the cost of their care.

They are also more likely to stay in hospital for a longer period of time following an emergency admission.

Compared with people from the wealthiest areas, patients from the poorest areas with bowel cancer spend four more days in hospital.

Poorer women with breast cancer spend three additional days in hospital while men from the most deprived areas spend five days longer in hospital.

People from the most deprived regions with lung cancer spend an average of two more days in hospital compared to those from the wealthiest parts of the country.

The researchers calculated the additional cost of hospital care for people in the most deprived areas.

They estimated that end of life hospital care for cancer patients in the most deprived areas of England costs the NHS an extra £4.6 million a year for these cancers alone.

"What our study shows is that there are significant disparities in end-of-life hospital treatment costs for cancer patients in England, largely due to a greater use of emergency care in patients from most deprived areas," said Dr Mauro Laudicella, senior lecturer in health economics at City, University of London.

"In contrast, use of elective care is more prevalent in patients from less deprived areas of England.

"Managing the health care needs of patients from most deprived areas more effectively could potentially reduce such disparities in costs, through the use of planned rather than emergency care, and a more effective use of palliative care.

"By investing in patients early on in their cancer journey, the NHS can slow down the spiralling cost of care, and ensure that in the future everyone who has cancer will be able to get the care they need."

Adrienne Betteley, Macmillan Cancer Support's specialist advisor for end of life care, added: "Access to the right care and support when you have advanced cancer should not depend on where you are from, or your socio-economic background. Yet too many people from the poorest parts of England are having to rely on emergency care towards the end of their lives, which can be incredibly traumatic for both patients and their families.

"Alongside the great human cost, there's a huge financial implication of poor access to care for dying people. That's why it's vitally important for the new Government to keep its promises about improving end of life care - which it committed to a year ago today, and repeated in its general election manifesto."

Commenting on the study, Simon Jones, director of policy and public affairs at the charity Marie Curie, said: "Inequities in cancer and end of life care remain a key issue, despite successive government commitments to cutting variations in care. Sadly it remains the case that around one fifth of people are first diagnosed with cancer following an emergency admission and that for these people life expectancy is significantly reduced. We also know from many studies that late diagnosis as an emergency admission is higher within deprived communities.

"This latest study highlights the importance of looking at this issue in more detail to help us understand exactly why those in deprived communities are experiencing more emergency admissions in their last six months of life than those who live in more affluent areas.

"Access to specialist palliative care is a very important aspect of ensuring that people have better planned care towards the end of their lives resulting in fewer emergency admissions. As is early recognition of symptoms leading to early diagnosis which would lead to a reduction in the unacceptably high number of people who are first diagnosed with cancer after having been admitted to hospital as an emergency."

Press Association